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Home My WebLink About05-09-11 (9)BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~~,. ~~~~ PENNSYLVANIA INHERITANCE INFORMATION NOTICE ~,,-,~~ ~ , .° ~ I~E CAF AND perm r~~ ~ ({~ {,j I J AXPAYER RESPO DEPARTMENT ~~,~[~~ a ~~i ~J ~~ ~ r .1.. ... C„~ REV-1543 EX AFP <OS-11) CL~~K GF 4RPFIA~'S COURT Ct)M~FP1.~P~1~ CCU , P~ BARBARA STOUTLEITZEL 613 N EAST ST CARLISLE PA 17013-2012 EST. OF EVELYN E= STOUT SSN 152-14-0346 DATE OF DEATH ~J5-22-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If yoU are the SpOUSe of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe he information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-83?7 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6250436104 Date 01-22-2007 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~` 26, 141 • O1 payable to "Register of Wills, Agent". Percent Taxable )( 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 4,356.92 months of the decedent's date of death, Tax Rate ~( 1~j deduct a 5 percent discount on the tax due. - Any inheritance tax due will become delinquent Potential Tax Due $ b53.54 nine months after the date of death. PART TAXPAYER RESPONSE 1D ~ .~ . ;`,° ~ s ~ ~ ~~ ~ ~~~,~(~~ SSESSMEt A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or return this notice to the Register of Wills and C H E C K an official assessment will be issued by the PA Department of Revenue. ONE BLOCK B. The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state ~ ~ ~ \\~ ~ relationship to decedent: TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS ~~~~` ~ ~~ ~ LINE 1. Date Established 1 \ \e\ \ ~\ \s 2. Account Balance 2 $ . . - \\\\ \\\\~\ \ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ ~ \ \\\ \\ 5. Debts and Deductions 5 \ ~~~~ ~\\\ \\\\\\\ \\\ ~ \ ~ ~~ \ 6. Amount Taxable 6 $ :. \ \ \ ~. \ \ ~ ~ ~\\~\\ \\\ 7. Tax Rate T X \ ~\~\~ ~~~\ 8. Tax Due 8 - \~~ DEBTS AND DEDUCTIONS CLAIMED PART nwr~ peTn PAYEE DESCRIPTION AMOUNT PAID IUTAL linter on L1nC ~ vi ia.. .rvmYw~c~. ~..••- Under penalties of perjury, I declare that the facts I reported above are true, correct and mple~t~es ~to t e best of my knowledge and belief . HOME C ~~ ~~ ) ~ /~~ ~~~ WORK t ~/ ' TELEPHONE NUMBER ATE • PAYER GNA E TAX FILE N0. 21 ..~ I~-~ ~~~ ACN 11145931 DATE 07-13-2011